The Helen Lester Memorial Lecture 2018: the leper squint: spaces for participation in primary health care.

Abstract

I want to tell you about the leper squint in St Mary’s Cathedral in Limerick City, Ireland. This is an architectural feature in the outer wall of the 800-year-old building that was designed to allow lepers to see Mass without having to come into the main body of the church. This was because lepers were feared and considered socially undesirable. As a consequence, they could not be admitted to the main space of the church where the rest of the worshippers were congregated. There are examples of the leper squint in many countries, and they reflect the genuine fear in medieval times that leprosy was contagious. However, we also know that behaviour towards lepers was a function of what sociologist Erving Goffman called ‘social stigma’ . This arises from negative labelling and stereotyping that discredits individuals, dehumanises them, and creates a real distance between ‘us’ and ‘them’.1 In this fifth Helen Lester Memorial Lecture, I would like to explore how the leper squint is an image that we can use to develop our understanding of spaces for participation in primary health care. I will focus on how these spaces are experienced by migrants, because this resonates with the theme of this year’s conference, ‘Populations on the Move’, and Helen Lester’s 2008 article about asylum seekers and the politics of health, which has disturbing parallels a decade later.2 In the social science literature about the conceptualisation of space, Doreen Massey’s work was ground-breaking. Following interpretive rather than positivist thinking, she emphasised that places and spaces not only have physical dimensions but are also shaped by temporal and social dimensions.3 This means that primary health care is something that is arranged and rearranged in different settings, in different ways, and in different times. It is not a ‘fixed’ entity: …